Promise Of The Pill Not Always Met

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Aired 8/31/10

"America & the Pill: A History of Promise, Peril, and Liberation," a new book by Elaine Tyler May, marks the 50th anniversary of the development of 'The Pill'. This history of how the birth control pill has affected Americans since its inception in 1960 explores everything from population control to Playboy, libido to liberation.

LECTURE AND BOOK-SIGNING Elaine Tyler May will be at the San Diego History Center, Balboa Park, tonight, Thursday, August 31, 2010, 6:00pm - 7:30pm.

ALISON ST JOHN (Host): Loretta Lynn there. I’m Alison St John, sitting in for Maureen Cavanaugh, and you're listening to These Days in San Diego. Some people credit the pill for liberating women, others blame it for opening the door on a new era of sexual promiscuity but nobody nowadays would say it has solved the world's population explosion. Yet that's one of the arguments that was used to get the pill approved 50 years ago this year. Elaine Tyler May, who is Regents Professor of American Studies and History at the University of Minnesota, has written a book, "America and the Pill: A History Of Promise, Peril and Liberation." It's an account that will resonate with anyone who’s ever agonized over whether to use the pill and perhaps surprise someone who’s taken it for granted. So, Elaine, thank you so much for joining us.

ELAINE TYLER MAY (Regents Professor, American Studies and History, University of Minnesota/Author): Thank you very much for having me.

ST JOHN: And we would like to invite you to call if you have any comments or questions at 1-888-895-5727. So, I think it’s safe to say the book was written from a feminist perspective so let’s start with the two women that you talk about who really were the mothers of the pill, Margaret Sanger and Katherine McCormick. Who were they and how did they meet?

MAY: Well, they have a really interesting story. They met in the early 20th century. They were both part of what is often called the first wave of feminist organizing. They fought for the vote in the early 20th century, they were involved in the early birth control movement. They were very strong feminists and they first met at that time and they were lifelong friends and colleagues in the movement.

ST JOHN: So why was it that they believed that they needed a contraception method that women could control?

MAY: Well, Margaret Sanger began life, her adult life really, as a nurse. And actually in her own family, she came from a devout Catholic family, and her mother had 13 pregnancies and 11 children and died at the age of 50, and she always thought that her mother was just worn out and basically died as a result of having so many children and she was very resentful about that. And then she began working in poor areas and realized how much the poor women who could not control their fertility suffered from too many pregnancies, too many childbirths, and too many abortions, often botched abortions where they would become incapacitated or died as a result. So this was an issue that was very real to her and she was very passionate about from very early on. Katherine McCormick was an interesting person as well. She came from a very wealthy, privileged background. She was one of the first women to graduate from MIT. She had a biology degree, so she had a science background. She married – right after college, she married the son of Cyrus McCormick, who was the inventor – or the person who founded International Harvester. And so she came into a lot more money through her marriage. And she and Sanger were both very strongly in favor of birth control and as early as, I think, 1916 or something like that, Margaret Sanger was already thinking about a pill that could be controlled totally by women. Her issue really, and McCormick’s as well, was for a birth control method that would be totally in the control of women. They didn’t have to ask men, they didn’t have to have their permission or their participation. And the pill was really the first contraceptive that did that, that gave women all of the control. So in their seventies, which was when they were obviously too old to benefit themselves, in the 1950s, they came together and just said, look, let’s make this happen. That’s when the field of reproductive medicine was taking off and there was a lot of research going on, mostly for infertility but it was the same process obviously. And it was a time when the whole idea of contraceptive research was somewhat disreputable…

ST JOHN: Yes.

MAY: …and…

ST JOHN: Fill us in a bit about what the feeling was about contraception back in those times. There was a postal inspector by the name of Anthony Comstock. Tell us about the Comstock Law.

MAY: Well, you know, Sanger and McCormick would be very familiar with Comstock. He was the postal inspector in the late 19th century who declared contraceptive information and materials to be the same as pornography, obscene materials, and managed to get a law passed in Congress that’s been known as the Comstock Law, that prohibited the transmission of any kind of birth control materials information through the U.S. mails. And Sanger, in particular, fought Comstock all of her life, sometimes actually successfully, and in the 1930s, managed to get an exemption for birth control, with the help of the medical profession at that point.

ST JOHN: So what kind of options did women have then back in the 1930s?

MAY: Well, they had – Well, there were always condoms available and other barrier methods. By the 1930s, the diaphragm was widely used, especially by middle class women. So the pill certainly wasn’t the first effective form of contraception but it was the first one that gave women full control over contraception.

ST JOHN: So in the 1950s, research into contraception was a bit of a disreputable field, right?

MAY: Right.

ST JOHN: So how did McCormick and Sanger get the support, the money and the researchers on their side to do the research?

MAY: Well, the researchers were interested in it but they couldn’t get any money from pharmaceutical companies. The big companies were afraid to get involved in it. The government wouldn’t support it. President Eisenhower said this is nothing for the government to be involved in. He later changed his mind. But – So basically it was McCormick’s money. She really funded the research for the pill in those early years. She put in her own personal fortune into it, millions of dollars of her own money. And she and Sanger found Gregory Pincus, who was the scientist who first began doing the lab work on it and then they went to John Rock, who’s the clinical researcher who is most well associated with the early human trials, and together they got the show on the road.

ST JOHN: And even although they were motivated to get a contraception for women, the arguments they used to convince the men were somewhat different, right?

MAY: Well, the men, most of the scientists and reproductive health physicians and professionals at the time had very idealistic, optimistic hopes for the possibilities of an oral contraceptive. They thought it would solve world population problems. They thought it would put an end to unwanted pregnancies. They thought it would put an end to unwed births, abortion, create happier marriages, bring down the divorce rate because people wouldn’t be afraid of having more children than they wanted. So they had very great idealistic hopes for the world-changing potential of the pill. They weren’t that interested in or really that focused on individual women. They weren’t doing this in order to benefit specifically individual women in their own hopes and dreams. They didn’t see it that way. But, of course, McCormick and Sanger, being longtime feminists, saw it exactly that way.

ST JOHN: They knew that that would be the motivation in many cases to get it off the ground once it was approved.

MAY: Well, they knew that the women were going to come after it and they did. Women instantly came for the pill and began to demand it as soon as it was available.

ST JOHN: So before we get to its approval, which is interesting, it’s only 50 years ago. It’s kind of amazing…

MAY: Right.

ST JOHN: …to think how recent it is.

MAY: Yeah.

ST JOHN: But before it was approved, how easy was it to find populations to test the new drug on?

MAY: Well, it was a problem. And the main problem was that in the United States in so many places it was illegal. Contraception of any kind was illegal. John Rock and Gregory Pincus practiced in Massachusetts. Birth control was illegal in Massachusetts for anyone, married, unmarried. It was just against the law. And John Rock knew he could test the pill for infertility purposes and that was one of the first applications. In fact, the same compound was approved for infertility treatment, the idea that you would take the pill briefly and suppress ovulation then go off the pill and it would trigger the return of a normal cycle. And John Rock was doing that and got approval for that compound for short term use for infertility treatment but not for long term use for contraception. And if he had tried to do long term testing of the pill on his own patients in Massachusetts, he could’ve been – he could’ve ended up in prison. It was a felony.

ST JOHN: Umm.

MAY: So they had to find a place where it was legal. There were some tests that were done in other places in the United States where it wasn’t against the law, California, for example. And then there were other places outside the country. Puerto Rico was a very big test site and often, I think to some extent unfairly, the researchers involved in that have been accused of racism and exploiting the women there. But what they don’t remember is that there was a huge network of contraception clinics in Puerto Rico, and the only thing available to those women was sterilization.

ST JOHN: Whoa.

MAY: Surgical sterilization. And the women of Puerto Rico, poor, having too many children, were desperate for a reversible form of contraception that they could control. And when these trials opened up and they asked for volunteers, women were lining up. They had to have waiting lists, there were so many Puerto Rican women who wanted to take part in these trials. So, you know, it’s true that there was a huge, massive dose of the – The early pill was massive. There were 10 milligrams of hormone, that’s huge. There’s a mere fraction of that now.

ST JOHN: Hmm.

MAY: But the researchers wanted to be sure that the pill would actually work. They wanted to be able to say to these women who volunteered, look, we know this will prevent pregnancy if you take it regularly every day. If they had started going down lower doses where they weren’t sure, there’s nothing they could do. Abortion was illegal. They couldn’t say, you know, we’ll be monitoring you and if you happen to get pregnant, within a day we’ll know and we’ll take care of it for you. That was illegal.

ST JOHN: Umm.

MAY: So you have to think of the context, that abortion was illegal then in many places in the U.S., in 22 states contraception was illegal. 22 states.

ST JOHN: That is amazing to think as recently as 1950s…

MAY: That’s right.

ST JOHN: …yeah. Umm-hmm. Yeah. So how long did it take them to reach a point where they discovered that it was effective?

MAY: Well, they knew it was effective. They knew very early on because they had done animal tests and they knew that it would work. And they knew that it suppressed ovulation because they were using it. It had already been approved for infertility work. So what they were trying to do was to determine what the effects would be for long term use, and that was the unknown. What would be the side effects? What were the risks?

ST JOHN: And that’s what unfolded.

MAY: Yeah.

ST JOHN: I was interested to learn that you only found out while researching for this book the important role that your own father played…

MAY: That’s right.

ST JOHN: …in the approval process.

MAY: That’s right.

ST JOHN: Yeah.

MAY: Well, I knew, of course, that my father was involved in the research. My father was one of several clinical researchers, he was a physician, he was an endocrinologist and he was involved in reproductive medicine. And he was one of the doctors who was testing the compound and various different compounds, actually, in Los Angeles. And I knew this. It was very exciting. I was 12 years old in 1960 when the pill was approved, and I remember it very well. And there was a lot of excitement and enthusiasm, and both my parents were involved in this. My mother was also an activist in the birth control movement. And – But I didn’t know until I began working on this book that my father was actually perhaps the key person in the actual approval process within the FDA, that they had consulted him and he was very cautious about the pill. He was not as – he was not in a big hurry. There were others. John Rock and Gregory Pincus on the east coast were very eager to get the pill approved and they were very angry at my father because he was more cautious and he wanted to be sure that it was safe. And for about a half a year he was not convinced that there was enough data to prove the safety of the pill.

ST JOHN: So by this point, the 1960s, there was quite an energy to approve it, to get it passed.

MAY: Huge momentum. Huge momentum…

ST JOHN: Umm-hmm.

MAY: …yes.

ST JOHN: Quite a shift but…

MAY: Yeah.

ST JOHN: …your father was one of the ones standing up for the safety of the women…

MAY: Right.

ST JOHN: …which is still an issue even now.

MAY: That’s right. It is still an issue. And it was always an issue for him.

ST JOHN: So now what was the reaction when the pill was introduced from women?

MAY: They just stormed their doctors for the pill. In fact, they stormed it even earlier than 1960. As soon as it was approved for infertility, what doctors knew and women knew was it suppressed ovulation. And it was approved for infertility treatment and for menstrual irregularity, and suddenly a half a million women showed up at their doctor’s demanding treatment for menstrual irregularity, a condition that was rarely, if ever, diagnosed and treated in that way. So you already had a half a million women getting prescriptions in the mid-to-late fifties before the pill was approved for contraception. And then as soon as it was approved for contraception, within a few years six million American women were on the pill.

ST JOHN: So what about the medical profession, were they – did they have any doubts about it? Or were they just happy to dispense the pill?

MAY: They were happy to dispense the pill. They were a little – a lot of doctors were taken aback because it began to shift the relationship between women and their doctors. This was a time, unlike today, where nearly all the doctors were men. It was very difficult for women to get access to medical training at the time. And so most of these doctors were men and there was a hierarchy and this was a time when doctors were treated almost as gods and men doctors were used to having women patients come to them and just sit quietly and the doctors would tell them what to take and they would take it and give them the prescriptions and that was that. So this turned things around. Women started showing up and demanding that their doctors give them the prescription and if the men for any reason, the doctors, were reluctant or unwilling, they would just take their business elsewhere.

ST JOHN: Now your book suggests that it’s a bit of a myth really to say that the pill is what liberated women. Why do you think that’s a mispercep – description of this situation?

MAY: Well, women liberated themselves. It’s very rare that a technology would actually create a cultural change, so one of the myths is that the pill was responsible for women’s liberation. I think it’s important to point out that it was the women’s movement that opened new doors and opportunities for women. And the pill, in a sense, made it possible for women to walk through those doors. Once you can control your fertility, you can control your life. But had it not been for the feminist movement, if nothing else had changed, the pill would’ve still been an important, major contraceptive innovation but it wouldn’t have been revolutionary. You know, if there’s nowhere to go with your liberation, if there’s no other opportunities, if there’s no jobs, no educational opportunities or, you know, public life or anything else, it would still be a good thing. But what made it revolutionary was the timing, that the pill came along just when the feminist movement came along.

ST JOHN: And you write that its biggest impact was actually within marriage, rather…

MAY: Yes.

ST JOHN: …than, you know, unmarried women.

MAY: Yes.

ST JOHN: What evidence to support that?

MAY: This is probably the biggest myth about the pill is that it sparked the sexual revolution. The sexual revolution was in process for a long time before the pill came along and, certainly, in the 1950s in a big way. And in 1960 things didn’t change dramatically in terms of sex outside of marriage just because the pill came along.

ST JOHN: You actually write a really interesting—I was very interested in this—research of students who left college as virgins.

MAY: Yes.

ST JOHN: You want to talk a bit about that?

MAY: Well, there’s this assumption that in the 1960s all sexual taboos dropped and everybody was having sex with everybody, and that just isn’t true. By the late 1960s, even on college campuses, which were considered to be the sort of center of the sexual revolution, the vast majority of young women who graduated college in the late sixties were still virgins when they graduated. And I think it’s important to realize that it was a lot more than the fear of pregnancy— that was part of it—but a lot more than that that prevented single women from having sex. There was a huge double standard. There was a taboo. It could ruin a woman’s reputation and if they got pregnant, of course, it was often a disaster even. Either they were forced into marriage or an illegal abortion. It was very hard to get a legal abortion in those years so the stakes were really very high. And the arrival of the pill didn’t suddenly change the culture…

ST JOHN: Umm…

MAY: …around sex outside of marriage. Now a lot of the advocates of the pill thought, well, it won’t change behavior but it’ll prevent people from getting – it’ll prevent young women from getting pregnant when they’re not married. That didn’t happen, of course. For one thing, it was very hard for single women to get the pill. A lot of states prohibited single women from getting the pill. In 1965, the Supreme Court ruled that married people could have access to the pill, and not until 1972 was that right extended to single women. So a lot of states still had laws, and a lot of doctors just wouldn’t prescribe it. So women would have to go in with fake wedding rings or say they were engaged or whatever and, of course, in some cases there were sympathetic doctors. But it was not an easy thing for a single woman to get the pill.

ST JOHN: Yeah, it – For people who now see it just as a part of life…

MAY: Right.

ST JOHN: …it’s amazing to think that as recently as 1972 is when they overturned that law in Connecticut banning…

MAY: Right.

ST JOHN: …advertising and selling it. And then the other aspect of it is this idea that it would solve the world’s fertility problems.

MAY: Right.

ST JOHN: So why didn’t it do that?

MAY: Well…

ST JOHN: The population explosion was such an issue but it didn’t really address that.

MAY: Right, there were a lot of reasons that it didn’t. But in most poor, developing countries the population was located in very small villages where it would be difficult to have the medical infrastructure available, and the pill was expensive unless it was available for free. And women in small villages likely wouldn’t have access to physicians or healthcare providers who could give prescriptions and provide follow-ups and refills and examinations and all of that. It really was unrealistic to think that the pill would be effective in that kind of a context. And what we’ve found is that where the real key to bringing population – well, at least fertility under control in the developing world has been the education of women more than anything else. If women are educated, they’re more likely to be in a position to have control over their fertility.

ST JOHN: You have a very interesting chapter about contraception methods for men and that scientists who took on researching male contraception were somehow seen as second class citizens in some cases. So what’s behind this very slow progress? We still don’t really have one, right?

MAY: That’s right. This was a really fun part of the project, was to trace the development of ideas about male contraception and especially the male pill. In the 1950s, when the pill for women was being developed, there were also experiments trying to develop a pill for men. And in the 1950s the word was, well, the male pill is just around the corner. And we still hear that today. We’ve been hearing it for 50 years and we still have no pill for men. Part of the problem is the science. It’s very difficult and it has proved so far impossible to find a compound that would have acceptable side effects for men. Now men are not at risk of getting pregnant. They’re, of course, at risk of procreating but they’re not at risk of pregnancy and many of the compounds that were tested then and are still under consideration affected men’s sexual performance and there’s just no way that men in huge numbers are going to go out and take a pill that’s going to affect their sexual performance.

ST JOHN: Although Viagra took off.

MAY: Exactly. I was about to say unless it’s in the other direction.

ST JOHN: Okay. So…

MAY: So…

ST JOHN: …that’s still waiting in the wings.

MAY: Yes.

ST JOHN: And is there any talk of it becoming a reality in the near future?

MAY: Yes. In fact, there’s still quite a bit of talk. And, in fact, there are some compounds that are now being studied that are non-hormonal compounds for men that do not have these side effects and so there’s a lot of optimism and I think the question is the pharmaceutical companies will need to be convinced that men will actually go out and buy it and take it before they’ll invest in the process.

ST JOHN: And in the minute or so we have left, where are we at now with the pill for women? I mean, what is slowing down more research on improving the pill for women?

MAY: Well, there are a lot of issues that are still out there even though a lot of people take for granted the pill. I did an internet survey and I heard back from hundreds of young women who were still very frustrated that abstinence only sex education is not allowing them to have the information they need to make informed choices about their own healthcare, that there’s still issues of accessibility and availability. There are conscience clauses now that allow pharmacists and other healthcare providers simply to not provide birth control to young women if they don’t agree with it or if they don’t approve of it. And the cost is still an issue. The subsidies have been removed from a lot of campuses for example. So oddly enough, 50 years later, still accessibility, affordability, availability, those are still issues.

ST JOHN: So Elaine Tyler May’s book is "America and the Pill: A History of Promise, Peril and Liberation.” And it’s a very easy little book to read, really fascinating. And you have a lecture tonight at Balboa Park at the San Diego History Center at six o’clock, from 6:00 to 7:30, so if you’re interested in finding out more and talking to Elaine, that’s in Balboa Park at the San Diego History Center tonight. Elaine, I’d like to thank you so much for coming in and talking to us about your book.

MAY: Well, thank you so much for having me. It was a pleasure.

ST JOHN: And stay with us. Coming up right after the break we’ll be meeting KPBS’s new military blogger, Jamie Reno, and talking about a new program to help members of the military deal with the stress of war.

It's forgotten now, post "Humanae Vitae", that many involved in working on a birth-control pill believed that the Church might be more amenable to such than to the barrier methods used then; I believe (but am not sure) that Alan Guttmacher claimed to have got such an opinion privately from a cardinal and other hierarchs. This was based on the thought that the Pill was less directly involved in the prevention of pregnancy; the Church ended up caring more about the intent, though in that case the rhythm method (where intent is often more significant than effect) should be ruled-out....

It's also not generally remembered that Western Europe, and especially France, achieved lower birth-rates in the 1890s and early 1900s, often even without access to barrier methods. The key points seem to be education of women and enough resources to make it reasonable to think of putting more of them into fewer children (example: have three children, send one to college or technical school).